Baby Skin Care

A guide to understanding newborn skin care

The skin of the newborn and that of the infant undergo significant anatomical and physiological changes at each stage of development. Understanding these differences in depth is essential in order to provide the most appropriate care at every stage.

Taking into account the specific characteristics of infant skin, the basic principles of newborn skin care are as follows:

The golden rule for caring for baby skin

With some nuances, there is one rule that always applies when in doubt: treat a newborn’s skin as if it were sensitive or reactive, even if it has not been diagnosed as such. In dermatology, we refer to sensitive or reactive skin when the skin is prone to irritation, itching, dryness, flaking, redness or burning sensations in response to everyday stimuli such as cold, heat, wind, heating systems, or contact with common agents like fabrics, cosmetics, plants or chemical products. Patients with this type of skin can prevent symptoms by adopting certain precautions and using specific products—precisely the same products that are suitable for babies with normal skin.

Hydration: essential for newborns

Many of the most common dermatological conditions in babies (diaper dermatitis, fissures, irritations, cradle cap, etc.) can be prevented or improved with adequate hydration. Newborn skin is more prone to dryness and to reacting when in contact with certain textile fibres or the diaper itself. Moisturising products for babies should be highly emollient but not excessively greasy, as overly occlusive products may promote skin infections or miliaria (inflammation of the sweat glands with small blister-like eruptions due to sweat retention). Vegetable oils added to bath water moisturise without clogging pores. When applied after bathing, they also facilitate a relaxing massage for the baby.

Avoid additives

Preservatives, fragrances and other ingredients commonly found in adult skincare products may irritate newborn skin. For example, propylene glycol is present in many moisturising creams and lotions and, at concentrations above 5%, can irritate a baby’s delicate skin. For the same reasons, ingredients such as methylisothiazolinone, sodium lauryl sulphate (SLS), sodium laureth sulphate (SLES) and ammonium laureth sulphate—foaming agents commonly used in gels, shampoos and toothpaste—are not recommended.

Protect your baby from the sun

Babies under six months of age should never be exposed to the sun. In fact, before this age, it is not advisable for them to visit beaches or swimming pools, even when under a parasol, as water and sand reflect solar radiation.
After six months of age, sun exposure should be very limited, always avoiding the central hours of the day and prioritising physical photoprotection (clothing, hats, sunglasses), complemented by sunscreens with a very high SPF, at least SPF 30.

Should babies be bathed every day?

This is one of the most frequent questions in our Paediatric Dermatology Unit. The answer is yes: newborns should be bathed daily, unless the baby is premature or there is a specific paediatric indication advising otherwise.

The ideal bath for a newborn

The water temperature should be around 37.5°C. Although this may feel slightly cool to adults, it is the most comfortable temperature for the baby and the most respectful of their delicate skin, helping to prevent irritation and dryness.

Bath time should not exceed five to six minutes. This is sufficient to cleanse the areas that require more thorough washing: the face, neck, skin folds in the buttock and thigh areas, the wrists, and the diaper area.

The use of sponges or harsh soaps is not recommended. A small amount of baby liquid cleanser diluted in the bath water is sufficient and should be applied gently by hand, taking the opportunity to soothe and massage the baby.

After bathing, the baby should be dried with a warm, soft cotton towel, patting gently without rubbing. Particular care should be taken to dry skin folds thoroughly, as moisture promotes maceration, small fissures and fungal infections.

“The golden rule for caring for baby skin is to treat it as sensitive or reactive, even if it has not been diagnosed as such”

Diaper area care

The key to good hygiene in the diaper area is removing waste and keeping the skin dry, ensuring that urine and stool remain in contact with the skin for as little time as possible.

There is no solid scientific evidence indicating that care routines should vary across paediatric ages (newborn, infant, toddler).

Generally, the most appropriate approach is to clean the diaper area with lukewarm water and a syndet cleanser (mild formulations specifically designed for delicate skin, also known as “soap-free cleansers”).

Cleaning should always be performed from front to back, using very soft materials to avoid excessive friction.

It is advisable to use nappies with adequate absorbency and breathability. They should be changed frequently throughout the day and as soon as possible after each bowel movement.

The correct diaper size should be used, avoiding overly tight fitting.

To reduce the risk of irritation, the use of an emollient after diaper changes may be beneficial. This product should preferably be formulated as a paste or ointment (rather than a cream or oil) and must not contain fragrances, preservatives or antiseptics.

Cradle cap

This colloquial term for infantile seborrhoeic dermatitis refers to the appearance of reddish patches covered with yellowish, dandruff-like scales, typically localised on the scalp. In more pronounced cases, lesions may also affect the eyebrows, ears, eyelashes, diaper folds or axillae; however, this is less common. In any case, this condition is not related to poor hygiene, nor is it contagious or allergic in nature.

There is no clearly established cause for cradle cap, and its intensity varies from one baby to another. Experts agree that sebum produced by the sebaceous glands — even in relatively small amounts — may act as an irritant on the baby’s delicate skin, contributing to the development of these characteristic scales.

Cradle cap usually resolves spontaneously with normal hygiene measures and gentle washing of the scalp using a mild baby shampoo that helps loosen the scales. In more severe cases, mineral or vegetable oils (such as almond or borage oil) may be used to soften the scales and facilitate removal. If the condition does not improve or causes discomfort, a dermatologist should be consulted to prescribe appropriate treatments. Home remedies or non-specialist advice may worsen the condition and compromise the baby’s health. Forced removal of scales should be avoided.

Physiological peeling in the first days of life

This is known as physiological desquamation and is completely harmless. It represents renewal of the outermost epidermal layer as the baby adapts to life outside the womb. It is not related to dryness or dehydration and resolves spontaneously around the second week of life. There is no need to use heavier or greasier creams or to apply them more frequently.

Neonatal acne and infantile acne

Neonatal acne typically develops within the first two weeks of life and is more common in boys than in girls. If acne appears after three months of age, it is referred to as infantile acne. It resembles adolescent acne, although it is generally less inflammatory. It is characterised by the appearance of small red papules, some with a white head (pustules), usually located on the forehead, nose, chin and cheeks. In the past, neonatal acne was associated with breastfeeding, leading some mothers to discontinue nursing out of concern that they were harming their baby. While this assumption is not entirely accurate, the condition is thought to be related to stimulation of the sebaceous glands by maternal hormones transferred during pregnancy, which may continue to exert an effect after birth.

Although maternal hormones stimulate sebaceous glands during pregnancy and after birth—and may also be present in breast milk—this condition is generally transient. If acne persists beyond three months, sebaceous gland stimulation may be accompanied by the presence of Malassezia, a microorganism also involved in other conditions such as pityriasis versicolor and seborrhoeic dermatitis. However, this association is not fully established, as Malassezia is part of normal skin flora. In most cases, it resolves spontaneously and does not require treatment.

Miliaria (heat rash)

Miliaria can be confused with infantile acne, but while acne appears only on the face, miliaria can affect the entire body, especially the forehead, chin, skin folds and back.

Scientific evidence has shown that miliaria (heat rash) is caused by obstruction of the sweat glands due to excessive heat or humidity. When a baby is overwrapped, the sweat glands produce perspiration; however, because these glands are still immature, bacterial proliferation may occur, leading to inflammation and blockage of the sweat ducts. As a result, sweat becomes trapped beneath the skin, producing the characteristic small papules of miliaria. This condition is more common during the summer months and usually resolves spontaneously within a few days.

Treatment is aimed at relieving discomfort and itching. It mainly consists of bathing the baby regularly to keep the skin clean, carefully drying the affected areas, and avoiding the use of very thick creams that may occlude the pores or products that excessively dry the skin. Once again, it is important to emphasise that talcum powder should not be used.

Although these small lesions are not serious, they can be uncomfortable for the baby, who may scratch and cause minor wounds with a risk of secondary infection. Some key recommendations to help prevent miliaria (heat rash) include:

• Maintain an appropriate room temperature The ideal temperature for the baby’s bedroom is around 19°C.
• Avoid overwrapping. Because babies do not regulate their body temperature efficiently, there is a common tendency to overdress them. While it is true that their thermoregulation is immature, there is no need to bundle them excessively. The general rule is to dress the baby in layers and add one more layer than the adult is wearing — preferably one that can be easily removed to adapt to temperature changes
• Choose natural fibres. Cotton and linen are recommended for baby clothing. These fabrics are breathable, soft and safe for newborn skin. Polyester and synthetic fibres should be avoided.
• Change nappies frequently. This helps prevent chafing, irritation, maceration and redness in the diaper area. Gentle hygiene. Clean the area with lukewarm water, paying particular attention to skin folds. Dry thoroughly afterwards, without rubbing.
• Avoiding excessive use of humidifiers, as high humidity combined with heat can trigger miliaria.

Wounds: covered or exposed?

Normal child development involves play and physical activity, which often result in blisters, abrasions and minor wounds that can usually be managed at home.

• Clean: Water and soap are sufficient.
• Disinfect: Use chlorhexidine or iodine (never together). Povidone-iodine should not be used in children under two years of age. Alcohol and hydrogen peroxide are too harsh and should be avoided.
  
• Do not blow on wounds: The mouth contains bacteria that can contaminate the wound.
  
• Cover: Use a breathable surgical dressing to promote healing and prevent contamination. Conventional plastic adhesive bandages are not recommended.
  
• Monitor: After 24 hours, uncover to check for inflammation, pain or pus. Change dressings daily, cleaning and disinfecting with each change.
  
• Avoid picking scabs: This delays healing and increases infection risk. If scabs are large or tight, softening creams or ointments may be used.

More information

Below you will find the authorship and references for the information provided on this page: